Wash. HCA Hospice Services Billing Guide, What are the requirements for the coordination of care?

A hospice agency must facilitate a client’s continuity of care with non-hospice

providers to ensure that medically necessary care is met - both related and not

related to the terminal illness.

Note: When the client is in a nursing facility and has elected

hospice, the hospice provider is responsible for reporting

changes of the hospice status or a change in living arrangement

to the HCS or the CSO financial worker.

This includes:

• Determining if HCA has approved a request for prescribed medical

equipment, such as a wheelchair. If the prescribed item is not delivered to the

client before the client becomes covered by a hospice agency, HCA will

rescind the approval (see WAC 182-543-9000).

Example: A nursing facility orders a wheelchair for one of its

clients. The client chose and authorized hospice care services.

The wheelchair arrives after the client has begun the first 90-day

election period. The hospice agency may pay for the wheelchair

or provide the medically necessary equipment. HCA reimburses

the hospice agency for the medical equipment through the

appropriate hospice daily rate as described in WAC 182-551-1510.

Note: It may be appropriate to rent equipment in some cases.

• Communicating with other Medicaid programs and documenting the services

a client is receiving in order to prevent duplication of payment and to ensure

continuity of care. Other programs include, but are not limited to, programs

administered by DSHS’ Home and Community Living Administration (HCLA).

• Documenting each contact with non-hospice providers.

Note: Both the POC and service plan must show the specific

duties and services each will provide to prevent duplication of

services.

When a client resides in a nursing facility, the hospice agency must do the

following:

• Coordinate the client’s care with all providers, including pharmacies and

medical vendors

• Coordinate the client’s care with all providers, including pharmacies, other

medical vendors, and any nursing facility that is providing room and board

• Provide the same level of hospice care the hospice agency provides to a client

residing at home

Once a client chooses hospice care, hospice agency staff must notify and inform

the client of the following:

• By choosing hospice care from a hospice agency, the client gives up the right

to the following:

o Covered Medicaid hospice services (e.g., adult day health) and supplies

received at the same time from another hospice agency

o Any covered Medicaid services and supplies received from any other

provider as necessary for the palliation and management of the terminal

illness and related medical conditions

• Services and supplies are not paid through the hospice daily rate if they are

any of the following:

o Proven to be clinically unrelated to the palliation and management of the

client’s terminal illness and related medical conditions

o Not covered by the hospice daily rate

o Provided under a Title XIX Medicaid program when the services are similar

to the hospice care services

o Not necessary for the palliation and management of the client’s terminal

illness and related medical conditions

A hospice agency must have written agreements with all contracted providers.